More prescription medication abusers in Allen County are switching to harder drugs at a time when a powerful synthetic opiates boom makes that risky move even more dangerous.
Almost all of the accidental overdose deaths resulted from drug addiction, and many of the addictions began with the abuse of opioid prescription painkillers.
More people abuse opioid prescription painkiller medications than all other drugs combined. They are more widespread and easily available than harder illegal narcotics and they seem safer because they are made by pharmaceutical companies.
There are cases where patients with a legitimate need for them have become addicted, but abuse increased as the recreational drug market exploded.
The mean age of an individual who died from an overdose was 43, and 69 percent were employed. A look at the largest demographic categories of the overdose deaths showed 60 percent were male, 88 percent were white, 50 percent finished their education at high school graduation, and 38 percent had never married.
Findings released in September of an Indiana University study conducted for the Indiana Chamber of Commerce showed 80 percent of the state’s employers have observed prescription drug misuse by employees, and 64 percent consider prescription drugs a greater workplace challenge than illegal substances.
They came from all walks of life.
Some individuals addicted to painkillers move to harder drugs for a stronger kick, and some addicts turn to drugs such as heroin when they have trouble finding prescription opioids such as Vicodin, OxyContin and Percocet.
“The issue with opioids is a person builds up tolerance. So, if I take opioids for a month and I take the same amount every day, at some point that’s not going to get me high or help me feel good, so I’m going to have to take more,” said Kevin Hunter, a captain with the Fort Wayne Police Department Vice and Narcotics Division.
Opioid addicts can get “dope sick” if they go too long without a fix. Because dope sickness is like a very, very bad case of the flu, they are motivated to seek drugs to avoid feeling horrible, he said.
The scenario has contributed to a spike in accidental overdose deaths in the county. From 2008 through 2015, Allen County saw 418 overdose deaths. Of those, 336, or 80 percent, were accidental, according to a study by the Fort Wayne Medical Education Program and the Fort Wayne-Allen County Department of Health.
Some Allen County residents started turning to illegal drugs around the same time that they were becoming more dangerous because they were unwilling or unable to adjust to a disruption in medically approved supply.
“The difficulties for a lot were run into in this community when a number of the pain physicians lost their ability to practice, and so those patients had difficulty landing somewhere to find a prescriber who was willing to continue with whatever regimen they were on,” said Dr. Gregory Eigner, associate director of the medical residency program.
Thousands of patients were affected. And with the fentanyl contamination of the heroin supply making matters worse, “I think we’ve had more deaths this year already as of this September than we did all of last year,” he said.
The number of overdose deaths in Allen County increased 93 percent from 2008. The share of overdose deaths that were accidental jumped to 68 percent last year from only 32 percent in 2008. The study, Retrospective Analysis of Overdose Deaths in Allen County 2008-2015, was based on information from the county coroner’s office.
“We’ve had a 40 percent increase in accidental overdose deaths from 2014 to 2015. Most of those people were working, most of those people had a life,” said Dr. Deborah McMahan, commissioner for the department, at a late October event where findings of the study were released.
“The jails are filled. DCS (Indiana Department of Child Services) is receiving more calls. Hospitals are reporting more overdoses; EMSs are reporting more overdoses. Every indicator you look at would suggest we’re on the uphill climb and we’ve not reached a plateau yet.”
A powerful synthetic opiates boom has made heroin use even more dangerous than it has been in the past because they are much more potent than heroin.
Fentanyl, for example, is 50 to 100 times more powerful than heroin, Hunter said and, in recent years, drug traffickers found a less expensive way to produce it by mixing chemicals rather than growing poppy plants and harvesting them for the resin.
When the right amount of fentanyl is mixed with diluted heroin, money can be made because customers can’t tell the difference. Sometimes fentanyl is mixed with heroin to market it as a higher grade of the drug. Also, pill presses are used for fentanyl to make counterfeit opioid prescription medications.
Because fentanyl and other synthetic opiates are so much more powerful than prescription drugs, it is easy to get the proportions wrong when mixing them with heroin and other substances. It is not unusual for drug dealers to not know the exact mixture they are selling.
They are losing customers on a regular basis to overdose deaths, but opioid abuse is growing so quickly they know “somebody else will take that spot,” Hunter said.
The money from a steady flow of new customers is good enough that drug traffickers don’t let any concern over the lives of existing customers get in the way of a sale. “We’ve had dealers in this area who knew they had a batch of fentanyl or fentanyl-heroin mix tell their users not to use this alone, and that’s really telling because fentanyl’s a very powerful drug that causes many overdoses,” he said.
Of the overdose deaths the study examined in Allen County, 57 percent occurred in a residence where others were present.
Immediate administration of Naloxone when an overdose begins may have been able to prevent some of those deaths by keeping people alive until emergency responders arrive, and it became available over-the-counter in Indiana this summer. The Fort Wayne Fire Department has reversed at least 89 overdoses this year when its crews arrived ahead of an ambulance.
“We’re seeing on a regular basis anywhere from 20 to 30 overdoses a week in the Fort Wayne and Allen County area, and some of those end up as being deaths,” Hunter said.
Overdose deaths due to fentanyl have tripled since 2013, and the study showed the share of Allen County overdose deaths involving fentanyl rose to about 35 percent last year from about 20 percent in 2008.
The U.S. Drug Enforcement Administration and Centers for Disease Control and Prevention issued nationwide alerts related to fentanyl last year. The CDC said overdose deaths related to it across the country increased 79 percent from 2013 to 2014.
Local medical and first responder communities are working to address the problem and the area now has more resources help treat chemical dependence, including improved programs that offer medication-assisted treatment with counseling.
With the improved treatment, “you basically go from single digit success rates to somewhere in the region of … 40 percent,” he said.
“It’s an issue you deal with for life. Once you’ve been there, there’s always a chance of relapse, but the longer you can put between using substances and not using them, the better your chances are of staying off them.”